Résumé
Objective: to study wide resection and arthrodesis of wrist, utilizing an autologous iliac crest for giant cell tumour of distal radius [Campanacci Grade-I I I]
Material and Methods: between Feb 2004 to Nov 2011 ,fourteen patients with amean age of 31 .5 years [21-42 years] with Campanacci Grade-Ill GCT of distal radius were admitted in orthopaedic ward Services hospital Lahore. Thirteen patients were managed with wide excision of tumour and reconstruction with ipsilateral iliac crest, fixed with small fragment plate to the remnant of radius. Primary autogenous iliac crest grafting was done at iliac crest radial junction in all the patients
Results: all the patients were followed to bony union, and twelve out of 14 patients were available at mean follow up of 24 months [10 to 26].The mean time to union was four months [3.0 to 6.0] at iliac crest-carpal site and 4.5 months [3.0 to 6.60] at iliac crest- radial site. Eleven patients had a reasonably good range of supination and pronation. The mean Musculoskeletal Tumour Society score was 23.21[77.38%, range21 to 25]. Among the complications, two patients developed radioulnar synostosis, one patient had a local recurrence, but with no bony involvement. Local excision was done and no local recurrence took place thereafter and he is disease free. One patient developed stiffness of fingers, which improved with physiotherapy. There was no other complications like nonunion at the graft bone junction, wound infection [superficial or deep], skin necrosis deformity and bony metastasis and refracture at the reconstruction site
Conclusions: iliac crest provides a local corticocancellous bone graft to reconstruct the defect left after excision of the distal radius for giant cell tumour. Iliac crest graft has advantage over the fibular and ulna graft of having the early union and better incorporation to the host bone, with no evidence of nonunion in our studies. It provides good stability at wrist with contouring of DCP over its concave surface, while retaining a good function of hand and forearm rotation